Acupuncture practitioners have developed various conventional medical techniques for treating patients. One such technique includes manipulation and insertion of needles into locations on the body of a patient, usually a human. This technique is typically practiced by inserting needles in accord with principles of traditional Chinese Medicine. The needles typically are made of stainless steel wire and generally vary in length between 0.51 to 5.1 inches and diameter between 0.006 inches and 0.018 inches. Shorter needles are inserted near the face and eyes. Longer needles are inserted in areas that include a lot of muscle. The thickness of the needle is determined based on the patient.
In Traditional Chinese Medicine, the location of the needle insertion is determined according to four diagnostic methods, including 1) inspection, 2) auscultation and olfaction, 3) inquiring, and 4) palpation. Inspection method includes analysis of the tongue for size, shape, tension, color, and coating, and teeth marks. Auscultation and olfaction method, respectively, refer to listening for particular sounds and perceiving body odor. Inquiring method includes “seven inquiries”, which are: chills and fever; perspiration; appetite, thirst, and taste; defecation and urination; pain; sleep; and menses and leukorrhea. Palpation method includes feeling the body for tender “ashi” points, left radial pulse, right radial pulse, Cun (proximal to wrist crease), Guan (one finger breadth proximal from wrist crease), and Chi (two finger breadth proximal from the wrist crease).
Traditional Chinese Medicine also teaches that a body includes channels such as energy channels, which are commonly termed meridians. The treatment needle is placement according to the location of certain meridians.
Certain disadvantages associated with needle-based therapy include pain at the site of needle insertion, fear of needles, and inconvenience of leaving needles in place for several days in some therapies.
Another method of acupuncture includes application of electric pulses to the skin of a patient at locations selected in accordance with the principles of acupuncture but without using needles that pierce the skin. Certain types of electrical pulse therapy have long been used in medicine to treat pain and other conditions. One of the forms of electrical pulse therapy is Transcutaneous Electrical Stimulation (“TENS”).
The “TENS” method is based on a hypothesis developed by the practitioners Melzack and Wallfrom 1965. They proposed that activity in coarse, afferent verve fibers (A-beta-fibers that convey pressure, touch, and vibration) inhibits impulse transmission in pain pathways at spinal cord level. The coarse nerve fibers have a low threshold for electrical stimulation and are therefore simple to activate by stimulation using electrodes placed on the skin. Stimulation frequencies of 20-120 Hz may be used for conventional TENS.
In recent years, Percutaneous Electrical Nerve Stimulation (“PENS”) has been used and investigated for the management of acute and chronic pain syndromes. PENS therapy utilizes needle-like electrodes placed in the soft tissues to stimulate peripheral sensory nerve at the dermatomal level corresponding to a local pathology.
PENS and TENS generally operate through different mechanisms of pain interruption along the ascending nociceptive pathways, namely, at peripheral, spinal segmental, and supraspinal. On the peripheral level, PENS stimulates mainly the pinprick A-delta and small type III fibers to achieve its effect. TENS stimulates mainly the A-beta and large type I fibers to achieve its effect. On the spinal level, the effect of PENS is mediated via the inhibitory enkephalinergic stalked cells in lamina II of the spinal grey matter. TENS is effectively mediated via interneurons with GABA receptors in the spinal cord which stimulate the inhibitory neurons. On the supraspinal level, PENS activates pituitary mechanisms releasing enkephalins and produces analgesia throughout the body. Conventional TENS are mostly segmental not involving pituitary mechanisms, and the analgesic effect is only segmental.
In clinical applications, PENS therapy seem to be significantly more effective than TENS therapy. Studies comparing PENS and TENS therapies tend to show that PENS was more effective in improving function, pain, physical activity of sleep. PENS therapy also appears to be preferred by more patients.
PENS therapy has been found to be effective in the management of pain associated with a number of conditions, including acute herpes, the prevention and management of migraine headaches, and cancer pain secondary to bone metastases. PENS therapy has been also found effective for many conditions including, but not limited to, Irritable Bowel Syndrome and dysmenorrheal.
Generally, a PENS therapeutic procedure may be performed in clinic by a pain specialist, typically, by physiatrist, anesthesiologist, or acupuncturist. A patient is usually placed on a table, when two or more electrodes are inserted in the back and around the spine, according to the location of the pain. Needle electrodes are kept in place for 30 minutes to 1 hour, while receiving an alternating electrical current generated at frequencies typically from several to 100 Hz.
Typically, the actual electrical current running through the electrodes is very small. More specifically, the current is typically administered in milliamperes. Such systems permit the electrodes to emit variable frequencies and intensities. Needle electrodes may be inserted perpendicular to the skin at variable depths, depending on the area, patient's anatomy, and the etiology of pain; typically the needles are inserted anywhere from several millimeters to several centimeters deep. Electrical clips with electrical wires are attached to the electrodes before an electrical stimulator is turned on.
These conventional methods of acupuncture have numerous limitations and disadvantages including risk of infection, skin damage, irritation, improper insertion, or additional pain. Therefore, there exists a need for improvement in the delivery of an electrical impulse to a patient.